Anxiety is estimated to occur in up around 10% of patients diagnosed with cancer,  in one third with heart disease, and two thirds of those with chronic obstructive pulmonary disease or with renal disease.  It can be a response to impending death, but may result from other untreated conditions or symptoms.
Anxiety: the palliative context
- Untreated pain
- Untreated or poorly managed symptoms
- An underlying anxiety disorder (e.g. panic disorder, phobia)
- Fear of death
- Family distress
- Drug induced.
Important contributing factors
- Previous psychiatric history
- Alcohol and nicotine dependence
- Long term benzodiazepine use
- Loss of control - real or perceived.
- Anxiety may be a result of an underlying anxiety disorder, untreated pain, or other untreated or poorly managed symptoms. [3,4]
- Anxiety and anxiety disorders frequently co-exist with depression. [5,6]
- A structured clinical interview is considered the ‘gold standard’ approach to detecting anxiety disorders.
- Related concerns at the end of life include:
- a sense of burden
- loss of dignity
- a desire for death. 
- There are pharmacological agents in use for patients at the end of life.  However, as yet there is no evidence from randomised controlled trials as to their effectiveness in a palliative population. 
- Mindfulness based therapies have been studied in a meta-analysis which suggests that these may significantly reduce symptoms of anxiety and depression. 
Active research areas / controversies
- The most widely used screening tool for anxiety is the Hospital Anxiety and Depression Scale (HADS) which has separate scales for depression and anxiety and enables the course of anxiety symptoms to be monitored over time. Concerns as to its sensitivity and specificity have been raised. [10-13]
- Given there is insufficient evidence to draw a conclusion about the effectiveness of pharmacotherapy for anxiety in terminally ill patients prospective controlled clinical trials are needed. 
- Death anxiety in older adults is shedding insight into the relationship of anxiety at the end of life. [14-16] Findings to date indicate that lower ego integrity, more physical problems, and more psychological problems are predictive of higher levels of death anxiety in elderly people.